1
|
Yang Q, Huang X, Lin Y, Chen K, Lu Q, Lin W, Wang X, Teng Y, Jiang P, Patil S, Zheng Y. Exploring the Multifaceted Landscape of Pediatric Obstructive Sleep Apnea: Insights into Prevalence, Severity, and Coexisting Conditions. Nat Sci Sleep 2024; 16:359-368. [PMID: 38617037 PMCID: PMC11012695 DOI: 10.2147/nss.s452221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
Background Pediatric obstructive sleep apnea (OSA) is a multifaceted disorder marked by recurrent upper airway obstruction during sleep, often coexisting with various medical conditions. This study, aimed to comprehensively analyze the Multifaceted Landscape of Pediatric Insights into Prevalence, Severity, and Coexisting Conditions. With a sample of 1928 participants, our study sought to determine the prevalence, severity, and associations between OSA and diverse conditions. Methods Conducted retrospectively from February 2019 to April 2023, the study included pediatric patients. Data were collected through electronic health records, involving clinical assessments, medical histories, and diagnostic tests to establish OSA and coexisting condition diagnoses. Relationships between sleep parameters, apnea types, and severity indices were evaluated. Results High OSA prevalence was evident across age groups, with severity peaking between 3 to 12 years. Among the participants, coexisting conditions included allergic rhinitis (59.6%), tonsillar hypertrophy (49.7%), adenoid hypertrophy (28.4%), and obesity (15.3%). Analysis revealed intriguing relationships between different sleep parameters and apnea types. Notable associations were observed between Obstructive Apnea (OA) and Central Apnea (CA), and Mixed Apnea (MA) displayed associations with both OA and CA. Hypopnea correlated directly with the Apnea-Hypopnea Index (AHI), reflecting its role in OSA severity. Conclusion This study provides a comprehensive understanding of the intricate dynamics between pediatric OSA and coexisting conditions. The prevalence of OSA and its coexistence with various conditions underscore the need for comprehensive evaluation and management strategies. By revealing associations between different sleep parameters and apnea types, the study emphasizes the complexity of OSA diagnosis and management. These findings hold the potential to enhance clinical approaches, ultimately leading to improved care and outcomes for affected children.
Collapse
Affiliation(s)
- Qin Yang
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Department of Sleep Centre, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Xiao Huang
- Department of Sleep Centre, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yanhong Lin
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Ke Chen
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Qinghua Lu
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Weinan Lin
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Xing Wang
- Department of Sleep Centre, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yishu Teng
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Peng Jiang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Sandip Patil
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yuejie Zheng
- Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| |
Collapse
|
2
|
Kilic M, Ede G, Uzuncakmak T. The reliability and validity of the Turkish version of the school-based asthma and allergy screening questionnaires. BMC Pediatr 2021; 21:348. [PMID: 34399733 PMCID: PMC8365918 DOI: 10.1186/s12887-021-02823-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Asthma is an important public health disease affecting children that may result in school absenteeism and hospitalization. This study aims to assess the validity, reliability, and diagnostic accuracy of the Turkish version of the asthma and allergy screening questionnaire. METHODS This study included primary and secondary school students from grades 2 to 7 and their parents or caregivers. For validity, 40 children with asthma and 39 children with allergies diagnosed by the questionnaire were used to determine the sensitivity. The specificity was calculated by using the data of 100 children without asthma and allergies. The study was completed with the participation of 704 students and parents. The intraclass correlation coefficient (ICC) was used to assess item reliability. Receiver operating characteristic (ROC) analysis was used to assess validity. RESULTS When the cutoff point of the questionnaire was 2/3 for asthma, the sensitivity was 80.0% and 82.5% and the specificity was 56.6% and 76.8% according to the student and parent form, respectively. When the cutoff point of the questionnaire was 0/1 for allergies, the sensitivity was 74.4% and 84.6% and the specificity was 66.3% and 54.2% according to the student (SQ) and parent questionnaire (PQ), respectively. The reliability of test-retest correlation values (≥0.68) of asthma and allergy questionnaires were found to be statistically significant. The internal consistency Cronbach's α values of the asthma SQ and PQ were 0.72 and 0.80, respectively. CONCLUSIONS According to the Turkish questionnaire for students and their parents, the sensitivity of asthma and allergy questionnaires was similar in proportion to the original questionnaire. The Turkish version of the questionnaire can be used for asthma and allergy screening in schools.
Collapse
Affiliation(s)
- Mahmut Kilic
- Faculty of Medicine, Department of Public Health, Yozgat Bozok University, E.Akdağ Kampüsü, 66900, Yozgat, Turkey.
| | - Ghaniya Ede
- Faculty of Medicine, Department of Pediatrics, Yozgat Bozok University, Yozgat, Turkey
| | - Tugba Uzuncakmak
- Faculty of Health Sciences, Department of Nursing, Yozgat Bozok University, Yozgat, Turkey
| |
Collapse
|
3
|
Crocker M, Loughlin CE, Esther CR, Noah T, Fernández SP, Woo G, Parajón LC, Parajón D, Becker-Dreps S. Community health worker case-detection of asthma or reactive airways disease in a resource-poor community in Nicaragua. Pediatr Pulmonol 2021; 56:1145-1154. [PMID: 33241927 DOI: 10.1002/ppul.25187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Asthma is a major cause of morbidity and mortality in children worldwide, but many cases may remain undiagnosed. Community health worker (CHW) programs have improved detection of other diseases such as childhood pneumonia, but none have been validated for detection of asthma in resource-poor settings. We hypothesized that a CHW administered questionnaire would be effective in case-detection of asthma in a poor Nicaraguan community. METHODS We enrolled children aged 2-17 from a small semiurban Nicaraguan community. A trained CHW administered a questionnaire based on a previously validated school-based screening questionnaire, which was compared to pediatric pulmonologist evaluation as a reference standard. We determined the questionnaire's sensitivity, specificity, and positive and negative likelihood ratios at different score cut-points. RESULTS A total of 199 out of 218 eligible children were enrolled. Total asthma prevalence based on physician diagnosis was 33%. Mean scores on the CHW questionnaire were 3.6 points out of 22 (SD = 4.3) for nonasthmatics and 11.0 points (SD = 5.3) for children with asthma (p < .001). Area under the curve was 0.87. Multivariable analysis showed increased association of asthma/reactive airways disease with respiratory infection in the first 3 months of life and with family history of asthma. CONCLUSIONS Prevalence of asthma in this community was high compared to previously reported national prevalence (15.2%), possibly due to increased exposure to risk factors. The questionnaire had a high area under the receiver operating characteristic curve, making it an excellent screening tool. This questionnaire could greatly increase the detection of asthma, allowing for education and referral for ongoing care.
Collapse
Affiliation(s)
- Mary Crocker
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ceila E Loughlin
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles R Esther
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Terry Noah
- Division of Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Sylvia Becker-Dreps
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
4
|
Benka-Coker WO, Gale SL, Brandt SJ, Balmes JR, Magzamen S. Optimizing community-level surveillance data for pediatric asthma management. Prev Med Rep 2018; 10:55-61. [PMID: 29868356 PMCID: PMC5984210 DOI: 10.1016/j.pmedr.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/03/2018] [Accepted: 02/05/2018] [Indexed: 11/25/2022] Open
Abstract
Community-level approaches for pediatric asthma management rely on locally collected information derived primarily from two sources: claims records and school-based surveys. We combined claims and school-based surveillance data, and examined the asthma-related risk patterns among adolescent students. Symptom data collected from school-based asthma surveys conducted in Oakland, CA were used for case identification and determination of severity levels for students (high and low). Survey data were matched to Medicaid claims data for all asthma-related health care encounters for the year prior to the survey. We then employed recursive partitioning to develop classification trees that identified patterns of demographics and healthcare utilization associated with severity. A total of 561 students had complete matched data; 86.1% were classified as high-severity, and 13.9% as low-severity asthma. The classification tree consisted of eight subsets: three indicating high severity and five indicating low severity. The risk subsets highlighted varying combinations of non-specific demographic and socioeconomic predictors of asthma prevalence, morbidity and severity. For example, the subset with the highest class-prior probability (92.1%) predicted high-severity asthma and consisted of students without prescribed rescue medication, but with at least one in-clinic nebulizer treatment. The predictive accuracy of the tree-based model was approximately 66.7%, with an estimated 91.1% of high-severity cases and 42.3% of low-severity cases correctly predicted. Our analysis draws on the strengths of two complementary datasets to provide community-level information on children with asthma, and demonstrates the utility of recursive partitioning methods to explore a combination of features that convey asthma severity.
Collapse
Affiliation(s)
- Wande O. Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sara L. Gale
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Sylvia J. Brandt
- Department of Resource Economics, University of Massachusetts, Amherst, MA, USA
| | - John R. Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
- Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| |
Collapse
|
5
|
Prevalence of Pediatric Asthma Risk in Santo Domingo, Dominican Republic. Ann Glob Health 2018; 83:293-299. [PMID: 28619404 DOI: 10.1016/j.aogh.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Early detection and treatment of pediatric asthma could reduce morbidity and lessen burden on society. Currently there is no known research on the prevalence of pediatric asthma in the Dominican Republic (DR) and no known asthma risk assessment tool for one-time encounters in a fast-paced clinic. OBJECTIVES To pilot a streamlined version of previously validated screening tools to estimate the prevalence of pediatric asthma risk in Santo Domingo Norte, DR. METHODS A combined asthma questionnaire and clinical assessment tool was developed and administered to patients aged 2-12 years. FINDINGS We found that 25.7% of the 74 study participants were categorized as probable asthma, 21.6% were at high risk for asthma, 14.9% elevated risk, and 37.8% not at risk. CONCLUSION If the prevalence of 25.7% is representative of the DR as a whole, the DR would have one of the highest national rates in Latin America. The study assessment tool was convenient to use, but tool validation is needed.
Collapse
|
6
|
Mejias SG, Ramphul K. Prevalence and Associated Risk Factors of Bronchial Asthma in Children in Santo Domingo, Dominican Republic. Cureus 2018; 10:e2211. [PMID: 29686953 PMCID: PMC5910008 DOI: 10.7759/cureus.2211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Bronchial asthma is an important health problem worldwide. There is insufficient data on the prevalence of bronchial asthma among school children in Santo Domingo, Dominican Republic. Objective The objective of this study is to assess the prevalence of asthma and its related risk factors among school children in Santo Domingo, Dominican Republic. Materials and methods A cross-sectional study using a modified questionnaire was conducted in Santo Domingo among 600 children aged three to 11 eleven years. The prevalence of asthma and its associated risk factors such as birth order, family history of asthma, family history of allergy, exposure to pets at home, exposure to tobacco smoke, and source of fuel used at home were collected. The relevant data collected was analyzed using the Statistical Package for the Social Sciences (SPSS) 24.0. (IBM Corp., Armonk, NY) software. Results The prevalence of asthma was found to be 22.0%. Age, family history of asthma, family history of allergy, exposure to tobacco smoke, and birth order showed statistical significance. The source of fuel used at home, gender, and exposure to pets were not statistically significant to be considered as risk factors associated with asthma in the population studied. Conclusion With an asthma prevalence of 22.0% in the pediatric population, the Dominican Republic has one of the highest national rates of asthma in the pediatric population in Latin America. Proper education, screening, and prevention can help lower the burden of this disease economically and socially.
Collapse
Affiliation(s)
- Stephanie G Mejias
- Department of Pediatrics, Robert Reid Cabral Children's Hospital Affiliated to the University Iberoamericana Unibe School of Medicine
| | - Kamleshun Ramphul
- Department of Pediatrics, Shanghai Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
7
|
Busi LE, Sly PD. Validation of the GLI-2012 spirometry reference equations in Argentinian children. Pediatr Pulmonol 2018; 53:204-208. [PMID: 29265696 DOI: 10.1002/ppul.23923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/15/2017] [Indexed: 11/06/2022]
Abstract
AIM The Global Lung Function Initiative (GLI) has produced spirometry reference equations for use in different ethnic groups. Previous reports have shown that the GLI equations do not adequately describe lung function in all populations and that adopting the new equations into clinical practice can increase the number of patients considered to have abnormal lung function. Therefore, before adopting these equations into local practice it is necessary to establish how well the equations represent the local population. The present study was conducted to determine how well the GLI spirometry reference equations represented the young children in Argentina, a population not included in the GLI dataset. METHODS Spirometry was measured in 2072 healthy children (50.9% males) aged 3.0-12.4 years (mean 6.64 ± SD 1.39), with a height range of 93.0-158.5 cm and weight range from 13.1 to 54.7 kg. We used the GLI "Caucasian" and "other/mixed" race equations to create Z-scores. RESULTS The Z-scores predicted by the Caucasian GLI equations did not differ from zero and fitted the data well. Z-scores calculated using "other/mixed race" fit less well. Using the GLI definition of low lung function (Z-score <1.65) 6.8% of our healthy population had abnormal FVC, 4.9% had abnormal FEV1, 5.9 % had abnormal FEV0.75, and 3.9% had abnormal FEF25-75 when using the "Caucasian" GLI equation. This compares well with the expected 5% below the lower limit of normal. CONCLUSION We recommend the use of the GLI-2012 Caucasian equations for spirometry undertaken in Argentinian children.
Collapse
Affiliation(s)
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| |
Collapse
|
8
|
Allen ED, Arcoleo K, Rowe C, Long WW. Implementation of a "real world" School-Based Asthma Therapy program targeting urban children with poorly controlled asthma. J Asthma 2017; 55:1122-1130. [PMID: 29190172 DOI: 10.1080/02770903.2017.1396472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Describe implementation and clinical impact of a "real world" School-Based Asthma Therapy (SBAT) Program serving an urban, largely Medicaid population in a large midwestern city in the United States. METHODS A retrospective, descriptive evaluation of SBAT was conducted. Students were referred by school nurses or providers, enrolled throughout the year, and could reenroll in subsequent years. A total of 286 students participated in the 2015-2016 school year. Kruskal-Wallis nonparametric testing compared Asthma Control Test™ (ACT) scores from enrollment (anytime between 2013 and 2015) to 2015-2016 for 198 students; and pre- and postenrollment asthma-related emergency department (ED), inpatient, and critical care (pediatric intensive care unit or PICU) utilization rates (events/student/year) for 98 students enrolled for a full year. RESULTS SBAT participation grew from 17 to 131 schools and from 38 to 268 students between 2013-2014 and 2015-2016. Mean ACT scores increased from 16.2 (SD = 4.89) to 21.37 (SD = 3.41) (K-W χ2 = 35.45, p = 0.008). Healthcare utilization rates from 1-year preenrollment to 1-year postenrollment decreased for ED (0.91-0.44; K-W χ2 = 18.61, p = 0.0002) and Inpatient (0.38-0.10; K-W χ2 = 7.68, p = 0.02). Reduction in PICU (0.27-0.02) was not statistically significant. CONCLUSIONS SBAT, modeled after programs shown in controlled trials to improve asthma health markers ( 1-3 ), was successfully implemented in economically challenged, urban schools. Rapid growth and patient reenrollment reflect program acceptance by schools, providers, and caregivers. Improved ACT scores and healthcare utilization supported program efficacy. SBAT could be one solution to improved asthma control in underserved school-aged pediatric patients.
Collapse
Affiliation(s)
- Elizabeth D Allen
- a Physician Lead, Asthma Quality Improvement, Nationwide Children's Hospital , Division of Pulmonary Medicine , Columbus , OH , USA
| | - Kimberly Arcoleo
- b Associate Professor & Associate Dean for Research , University of Rochester, School of Nursing , Rochester , NY , USA
| | - Courtney Rowe
- c School Based Asthma Therapy (SBAT) Program Nurse Practitioner , Nationwide Children's Hospital , Columbus , OH , USA
| | - William W Long
- d Associate Administrative Medical Director , Nationwide Children's Hospital , Columbus , OH , USA
| |
Collapse
|
9
|
Busi LE, Restuccia S, Tourres R, Sly PD. Assessing bronchodilator response in preschool children using spirometry. Thorax 2016; 72:367-372. [PMID: 27742871 DOI: 10.1136/thoraxjnl-2015-207961] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Measuring lung function, including bronchodilator response (BDR), is an integral part of asthma management in older children. While spirometry is possible in preschool-aged children, the question remains whether measuring BDR aids in asthma diagnosis in this age group. METHODS 431 healthy children and 289 children with asthma, aged 3-5 years, were recruited from kindergartens and the pulmonology clinic in Trelew, Argentina. Spirometry was performed at visit 1 and repeated after 15 min, with children randomised to placebo or salbutamol (400 µg). Spirometry was again performed within 8 weeks at visit 2. Within-session repeatability from visit 1 and between-session reproducibility were calculated using baseline spirometry. The within-session repeatability and receiver operating characteristic curve analyses were used to determine the optimal threshold values for BDR for spirometry outcome variables measured at the first visit, and sensitivity, specificity and diagnostic accuracy were determined. RESULTS As a group, children with asthma had lower lung function (FVC 1.11±0.12 L vs 1.01±0.15 L; FEV0.75 1.01±0.10 L vs 0.91±0.15 L) and a greater BDR (FEV0.75 group difference 8.6 (95% CI -5.0 to 14.3)%) than healthy children. BDR was best defined by change in FEV0.75; an increase of 11% showed the best balance between sensitivity (51%), specificity (88%), positive predictive value (47%) and negative predictive value (89%) for discriminating healthy from preschool-aged children with asthma. CONCLUSIONS A negative BDR in a child suspected of having asthma makes a diagnosis of asthma less likely.
Collapse
Affiliation(s)
- Luciano E Busi
- Pulmonology Committee of the Argentinean Pediatric Society, Trelew, Argentina.,Trelew Hospital, Trelew, Argentina
| | | | | | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| |
Collapse
|
10
|
Busi LE, Sly PD, Llancaman L. Validation of a questionnaire for asthma case identification in pre-schools in Latin America. Respirology 2015; 20:912-6. [PMID: 26108133 DOI: 10.1111/resp.12575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/27/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE We recently developed and validated a screening questionnaire for determining which school-aged children may need further investigation to diagnose and manage asthma. In the present study we sought to extend this to pre-school aged children. METHODS Questions from the school-aged questionnaire and literature on pre-school asthma were used to inform a focus group of parents with pre-school-aged children with asthma to develop a screening questionnaire. Parents of children attending 6 randomly selected kindergartens in Trelew, Argentina (n = 639) were invited to respond to the questionnaire. A reliability test-retest was undertaken in 187 randomly selected parents who completed the same questionnaire twice within 2-5 weeks. Clinical assessment included a standardized history and physical examination, spirometry before and after a β-agonist inhaler, and chest X-ray. Asthma was diagnosed by the pulmonologist. RESULTS Completed surveys were returned for 620 children, 607 of whom underwent clinical evaluation. The mean age was 4.21 years (range of 3.01-5.50) and included 82.5% white and 49.4% male children. Asthma was diagnosed in 103 (17.0%) children); 72 (69.9%) of these children did not have a previous diagnosis of asthma. The specificity, sensitivity, positive predictive value and negative predictive value of the questionnaire were 93.2%, 86.1%, 57.8% and 98.4%, respectively. CONCLUSIONS We have demonstrated the utility of a screening questionnaire for identifying pre-school-aged children who may benefit from further assessment for asthma.
Collapse
Affiliation(s)
- Luciano E Busi
- Pulmonology Committee of the Argentinean Pediatric Society, Trelew Hospital, Trelew, Argentina.,Pediatrics Department, Trelew Hospital, Trelew, Argentina
| | - Peter D Sly
- Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | | |
Collapse
|
11
|
Hansen TE, Evjenth B, Holt J. Validation of a questionnaire against clinical assessment in the diagnosis of asthma in school children. J Asthma 2014; 52:262-7. [PMID: 25233047 DOI: 10.3109/02770903.2014.966914] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM A questionnaire has been used repeatedly in cross-sectional studies to determine the prevalence of asthma, allergic rhinoconjunctivitis (AR) and eczema among schoolchildren in Nordland County, Norway. The current study was designed to validate the questionnaire against clinical assessment as the diagnostic gold standard and to investigate the extent of possible misclassification. METHODS A subsample of 801 schoolchildren of 4150, whose parents had answered a questionnaire covering asthma and atopic diseases, underwent a detailed clinical evaluation including a standardized interview, a clinical examination, skin prick tests (SPT), blood samples, spirometry an exercise treadmill test (EIB test) and measurement of exhaled nitrogen oxide (FeNO). RESULTS The questionnaire had a sensitivity of 0.96 and a specificity of 0.87 for the diagnosis of asthma ever compared to clinical assessment. The overall agreement (kappa) was 0.80. After clinical assessment the prevalence of asthma ever was adjusted from 17.6 % to 16.9 % (95% CI: 15.8-18.0). The most sensitive and specific questions in identifying asthmatic children by the questionnaire were questions asking about diagnosis ('Has the child ever had asthma?') rather than those covering asthma symptoms such as wheeze, shortness of breath and/or cough. A positive exercise test increased the post-test probability for the asthma diagnosis only to a minimal degree. CONCLUSION Based on the good agreement between the questionnaire responses and the clinical assessments, it is concluded that the questionnaire had good validity and served as a useful epidemiological tool. Detailed clinical testing added little additional information.
Collapse
Affiliation(s)
- Tonje Elisabeth Hansen
- Division of Pediatrics, Obstetrics and Woman's Health, Nordland Hospital , Bodø , Norway and
| | | | | |
Collapse
|
12
|
Silverberg JI, Joks R, Durkin HG. Allergic disease is associated with epilepsy in childhood: a US population-based study. Allergy 2014; 69:95-103. [PMID: 24251558 DOI: 10.1111/all.12319] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous studies using animal models suggest an association between allergic disease and epilepsy. We sought to determine whether allergic disease is associated with epilepsy in children. METHODS We used the 2007-2008 National Survey of Children's Health, a US population-based study of 91 642 children aged 0-17 years to determine the association between the prevalence of epilepsy and allergic disease, including asthma, atopic dermatitis (AD)/eczema, hay fever, and food allergies. Multivariate logistic regression models were constructed that controlled for confounding variables. RESULTS The US lifetime prevalence of childhood epilepsy was 1.03% and was significantly associated with older age, male sex, lower household income, family structure and history of brain injury or concussion. Children with ≥1 allergic disease had more epilepsy in their lifetime than nonallergic children (logistic regression, adjusted odds ratio [95% confidence interval] = 1.79 [1.37-2.33]). Lifetime prevalence (2.30 [1.50-3.52]) and one-year prevalence of asthma (2.00 [1.41-2.84]), AD/eczema (1.73 [1.17-2.56]), hay fever (1.93 [1.41-2.65]) and food allergies (2.69 [1.38-4.01]) were associated with increased odds of ever being diagnosed with epilepsy. Similar results were found for current history of epilepsy. Severe AD/eczema (3.89 [1.34-11.32]) [corrected] and hay fever (2.46 [1.11-5.41]) were associated with even higher odds of epilepsy compared with mild/moderate disease. As the number of allergic diseases increased, so did the odds of lifetime history and current history of epilepsy. CONCLUSIONS The US prevalence of epilepsy is associated with allergic diseases in children. Further studies are needed to determine whether allergic inflammation contributes toward epileptogenesis.
Collapse
Affiliation(s)
- J. I. Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences; Northwestern University; Chicago IL USA
- Department of Dermatology; Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center; New York NY USA
| | - R. Joks
- Center for Allergy and Asthma Research; State University of New York Downstate Medical Center; Brooklyn NY USA
- Departments of Medicine; Allergy and Immunology; State University of New York Downstate Medical Center; Brooklyn NY USA
| | - H. G. Durkin
- Center for Allergy and Asthma Research; State University of New York Downstate Medical Center; Brooklyn NY USA
- Department of Pathology; State University of New York Downstate Medical Center; Brooklyn NY USA
| |
Collapse
|